Elbow Arthroplasty - Historical Perspective

According to R. Dee[1], one of the first accounts of resection arthroplasty of the elbow was described in 1780 by Park of Liverpool and Moreau of France. The surgery involved an aggressive extraperiosteal resection of the entire elbow joint. Unfortunately, the pain relief afforded by the resection arthroplasty tends to come at the expense of instability. Resection arthroplasty is currently considered a salvage operation in patients with failed total elbow arthroplasty or uncontrollable infections.

Interposition arthroplasty was introduced by Defontaine in1887 [2]. Interposition arthroplasty involves less bone excision and incorporates the use of fascia, fat, skin, or other material as a spacer between the surfaces of the distal humerus and proximal ulna.The goal of this technique is to precent joint instability seen in resection arthroplasty. It also aims to allow full and pain free motion. Currently, candidates for this technique are young, motivated patients with posttraumatic bony or fibrous anklylosis with pain and/or motion limitation.

Arthrodesis, the surgical treatment of uniting the humerus and ulna by rigid fixation, seeks to provide stability and pain relief at the expense of negating functional flexion and rotation of the elbow joint. Currently it is rarely indicated given the advancements in total elbow arthroplasty.

The modern era of total elbow arthroplasty is considered to have begun in 1972 when Dee implanted cemented, hinged elbow replacements in 12 rheumatoid patients [3]. Following this achievement, a rapid evolution occurred in the appreciation and understanding of elbow biomechanics, implant design and composition, and surgical technique. Additionally, the "loose hinge" strategy was adopted in the1970's when studies showed that the elbow joint did not function simply as a hinge--it also has a small amount of rotational and side-to-side motion throughout extension and flexion.